Integrating HIV Chaplains into Clinical Care: A Qualitative Evaluation of a Faith-Based Model for Promoting Adherence and Retention in Antiretroviral Therapy

Background Persistent gaps in antiretroviral therapy (ART) adherence, retention in care, and viral suppression continue to limit progress toward the UNAIDS 95-95-95 targets, particularly in settings where psychosocial, spiritual, and stigma-related barriers remain strong. Faith communities exert significant influence on health behaviours in Nigeria, yet structured models that integrate trained religious leaders into routine HIV care remain underexplored. This qualitative study examined the perceived impact, mechanisms, and contextual dynamics of an HIV chaplaincy intervention implemented in Nigerian. Methodology: Using a qualitative design, the study conducted in-depth interviews, key informant interviews and focus group discussions with people living with HIV (PLHIV), chaplains, health workers, and programme managers. Data were analysed thematically using an inductive-deductive approach. Result Findings demonstrate that integrating HIV chaplains into clinical settings can address psychosocial and spiritual barriers to care, reinforce adherence behaviours, and promote self-destigmatization. Five interconnected themes emerged: (1) faith-based psychosocial and improved adherence; (2) stigma and internalised shame decreased through faith-informed sermons and compassionate engagement; (3) faith–biomedical reconciliation aligned spiritual beliefs with ART adherence, reducing reliance on faith-healing-only narratives; (4) spiritual trust facilitated re-engagement of clients who had defaulted from care; and (5) institutional collaboration between faith networks and facilities enhanced programme ownership and sustainability. Conclusion The model bridged the gap in faith and bio-medicine, and offered a culturally grounded pathway to strengthen treatment continuity. These insights provide actionable evidence for scaling faith-sensitive spiritual care as part of comprehensive HIV service delivery in high-burden, faith-influenced contexts.